Nitazenes, a group of potent synthetic opioids, are fuelling a global overdose crisis, with rising fatalities across Europe and North America. In Australia, nitazenes are only just making their mark, from hip inner-city nightclubs to needle exchanges. Australia faces an urgent threat that has the potential to fuel organised crime, increase overdoses, destabilise communities and create a new generation of people with an addiction.

The government must take decisive action to safeguard public health and take harm-reduction measures.

Understanding the nature of opioids is crucial to grasping the potential implications of a rapid take-up of nitazenes in Australia.

Natural opioids, derived from the opium poppy, interact with the brain’s receptors to block pain and elicit euphoria. Opioid abuse affects the brain’s limbic system, leading to a reliance on these drugs for emotional regulation, as well as increased risks of overdose and death.

Developed in the 1950s, nitazenes were never approved or marketed for medical use due to their extreme toxicity. Their reemergence can be traced back to the Taliban’s return to power in Afghanistan. The Taliban first cracked down on opium production in 2000, implementing a strict ban that drastically reduced poppy cultivation. This ban led to a shift in the global heroin supply chain. Opium production in Myanmar rose in response, and so too did production of synthetic opioids in China. After the Taliban returned to power in 2021, they again cracked down on opium in 2022. This time the gap is being filled almost exclusively by a surge in Chinese production of synthetic opioids production, particularly nitazenes.

Over the past three years, nitazenes have surfaced on the streets of major cities in North America and Europe. In Britain, an estimated two people die each week from nitazenes overdoses, and the crisis is worse still in the US, where thousands of Americans are dying from overdoses each year.

In Australia, the precise scope of nitazenes use remains difficult to determine. Though the Australian Criminal Intelligence Commission has yet to find substantial evidence in wastewater analysis, a small number of cases have emerged since 2021. Coronial data reveals at least three overdose deaths linked to nitazenes in Victoria alone. In the same period, the Australian Federal Police and Australian Border Force have intercepted shipments. It is clear that this threat is no longer a distant concern.

Australia’s illicit drug market doesn’t always follow global trends. The North American crack epidemic of the 1980s and 1990s devastated communities, where this cheap and highly addictive form of cocaine fuelled a crime and health crisis. The idiosyncrasies of Australia’s drug markets, law enforcement approaches and geographic isolation helped to limit the spread of crack cocaine. Its relatively strong public health policies and lower demand for cocaine further limited negative effects.

The danger of nitazenes may be due to unintentional consumption. Globally, dealers often mix nitazenes with heroin and counterfeit pills, creating lethal cocktails. They do so because nitazenes, being strong, are imported by organised crime groups in much smaller quantities than other drugs. They’re harder to detect and offer larger profits. Substitution of non-opioid drugs by nitazenes dramatically increases risk of accidental overdose.

At the same time, many dealers may be unaware of what they are selling, and users often don’t know what they’re taking.

The priority for any government response should be harm minimisation. The government should consider expanding access to the life-saving medication naloxone and providing comprehensive training on its use. Naloxone rapidly reverses opioid overdoses by blocking opioid receptors in the brain and thereby preventing fatal respiratory failure. Its wide distribution is crucial to public health because it provides immediate, accessible intervention during overdose emergencies.

Drug testing and screening services are also critical in addressing nitazenes. Such services allow users to identify dangerous substances in their drugs, helping to prevent accidental overdoses. Users can make safer choices, and the public health risks associated with unintentional exposure to highly toxic substances is reduced.

The Australian government should implement broad drug testing and screening services to safeguard public health and effectively mitigate the risks posed by these emerging threats.

Implementing comprehensive education on safer drug use practices, alongside personalised treatment options for those with opioid use disorders, will be essential in mitigating the risks associated with these potent synthetic opioids. Furthermore, fostering improved public communication that is free from stigma can encourage individuals to seek help and raise awareness about the dangers posed by nitazenes.

Without swift and comprehensive action, we risk plunging into a nitazenes-driven overdose epidemic.